Healthcare Needs a More Robust Feedback Loop

As recently as 2007, gathering and publishing doctor reviews was greeted with outrage. Some doctors resorted to gag orders to prevent themselves from being publicly reviewed, others filed lawsuits.

The backlash against doctor reviews – which still flares up from time to time – smacks of a certain paternalism that is a big part of what has made patients feel alienated from a system that’s sworn to care for them.

Doctors argue that consumers have no way to judge the precision of a procedure or the variables that affect outcomes. There’s some truth to that. A patient may never be able to assess how well a surgeon performs a stent surgery. In fact, quantitative metrics do a better job providing that information.

But bedside manner and patient confidence levels are a different matter entirely.

Personal experience has always been considered a valid indicator of quality in the provision of services in our economy. Companies regularly require potential employees to provide references. Politicians rely on the power of endorsements. Feedback on physicians also clearly holds certain truths for would-be patients.

Of course, by their very nature, reviews are subjective. But reviews can be aggregated, allowing the sum total of opinion to take on a more objective quality. It’s often called the “wisdom of crowds” or statistical sampling. One or two reviews or comments can be outliers, colored or emotional. But gather more than a dozen reviews, and broad truths begin to emerge. In other words, opinions become more empirical in aggregate. We all pay at least some attention to the number of stars a product or restaurant gets in an app or an online service.

The collection of reviews by patients represented one of the first power shifts to disrupt the traditional hierarchical structure of medicine. Consider this: Patient records are kept now not by the patient, but at the doctor’s office. And they can be hard to access or understand. Medical data is rife with jargon that is frequently incomprehensible to the average reader.

But with the power of the computer, crowds step into a central role. Entire online communities have cropped up to offer support and medical advice to caregivers and patients with a vast range of chronic conditions, cancer and other debilitating diseases. They swap stories on the effectiveness of drugs, help people locate clinical trials and even suggest lifestyle changes that might improve their prognosis.

As collective knowledge is shared, consumers become empowered – and more demanding – resulting in a viable health care marketplace, one that rewards and punishes based on similar criteria as in many other industries. More and more, patients today want to know: Did I get a good product? Did it work as it was supposed to? Was I satisfied with the results?

Of course, these days, feedback to patients is also digital. Huge terabytes of data are helping people live healthier. And technology can build the links between one’s everyday life and medical advice and care teams.

For instance, data feedback from self-tracking apps and wearable devices raises people’s understanding of their health status and encourages changes in behavior. Group feedback from others in app and online environments gives people the motivation to stick with healthy behavior. Many apps allow friends to comment on progress, reinforcing those behavior changes.

But while most people today track weight, nutrition or exercise, the apps of tomorrow will allow people to measure ever more detailed vital signs. This information will eventually integrate with patient’s electronic health records, allowing doctors and patients to collaborate on treatment plans based on real-time data from a patient’s everyday life. The company I help run, Vitals, offers tools to engage patients in their healthcare, by shopping for a quality provider at the best price.

Yet, feedback isn’t just a change agent for consumers. It also affects doctors. In part, medicine has always relied on apprentice-style mentoring to train doctors in the workplace. Yet, too often, doctors adopt the treatment standards of their mentors at a clinic or hospital without question.

This leads to medicine being practiced in significantly different ways across different parts of the U.S., which in turn creates huge cost variations and disparities in value of care. In fact, costs and quality vary most when research says little on the safest and most effective form of care.

But the availability of clinical feedback and data can standardize care, reduce costs and improve outcomes. In fact, one study showed that when doctors were aware of a median volume of x-rays ordered by their peers, their use of testing either increased or decreased to fall in line with the norm.

In the end, the feedback loop created by both crowds and computers is enabling everyone to actively participate in the betterment of the system. It increases competition among providers, creates engaged, empowered consumers who can manage their care, and helps doctors practice better, more affordable care.

Mitch Rothschild is Executive Chairman and Founder of Vitals. This article will run in longer form as part of the Health Rosetta Principles at www.healthrosetta.org